Women in prenatal care who chose not to be screened for HIV were more likely to be infected than those who opted to be tested, according to a new Canadian study.

In a review of more than 110,000 women in Alberta receiving prenatal infectious-disease screening from 2002 to 2004, fewer than 4 percent opted out of HIV testing, reported University of Alberta's Dr. Ameeta E. Singh and associates.

Reasons for opting out could not be determined, as the identities of women were unknown at the time of analysis, the team said. However, newly diagnosed HIV prevalence among the opt-out group was 3.3 times greater than those who were tested (0.07 percent vs. 0.02 percent), the authors report.

"This may indicate that women at higher risk for HIV infection are opting out of testing," the investigators wrote. "HIV testing in pregnancy is essential to improving health care for HIV-infected women and to prevent mother-to-child transmission of HIV," said Singh. "Anything less than truly universal HIV testing in pregnant women is likely to result in missed opportunities to prevent mother-to-child transmission of HIV."

The full report, "HIV Seroprevalence Among Women Opting Out of Prenatal HIV Screening in Alberta, Canada: 2002-2004," was published in Clinical Infectious Diseases (2007;45(12):1640-1643).

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